6 Respect7 Autonomy/ 8 Veracity/ 9 Fidelity

RespectRespect is our moral duty to treat people in certain waysIt is the characteristic of these norms that determines what is morally right rather than the consequencesThese views are called formalism or deontology, which means certain behaviours are our duty even if there is no benefit, eg. Avoidance of killing or lying

BiomedicalThose who refer to the principle of respect for persons then derive the duty to respect autonomy, to tell the truth, to keep promises and to avoid killing peopleBeauchamp and Childress included the principle of respect for autonomy as one of four (beneficence, nonmaleficence, justice) principles of Biomedical ethics

PersonsSome commentators define a person as a being who is self aware or self consciousThis definition means that many living human beings such as babies or individuals with alzheimers are not personsWhereas others believe the opposite

Code of EthicsIt seems arguable that some living humans who might not be considered persons, deserve maximum respect The first statement in the ANA code of ethics states: The nurse in all professional relationship, practices with compassion, and respect for the inherent dignity, worth and uniqueness of every individual

7 AutonomyIt is believed that we owe others respect for the autonomy and that showing such respect might be more important than producing benefits for othersOften the goals of doing good and avoiding harm come into conflicts with other principles as respect for autonomy, truth-telling and promise-keeping

Decision makingRespecting autonomy means that persons with decision-making capacity have the right to make these decisions.Decision making capacity is: a. the ability to comprehend information, b. able to deliberatein accordance with his own values and goals, c. ability to communicate with caregivers

IncompetenceMedical ethics recommends a sliding scale model of capacity determination, with consent or refusal being more stringent Strictly speaking only the courts have the authority to declare a person incompetentWe can refer to individuals who lack capacity as one who lacks decision-making capacity

ChoicesIn respect for persons who support respect for autonomy, one would need to accept the individuals choices even if its not in their interestInternal constraint on autonomy is that small children or severely retarded has never had that capacity

8. VeracityAnother characteristic that people believe is morally required for reasons other than producing good consequences is telling the truth in personnel communicationThe nurse needs to assess whether communication is honestWe might face situations at times when being honest will be inconvenient to staff and harmful to pt.

9. FidelityFidelity is about a moral obligation to keep commitments that are madeIf you fail to do this, it is a mark of disrespect. Part of commitment is making a promiseWhen a promise is made there is an ethical obligation to keep it as a principle of fidelity

Breaking a promiseThe duty of fidelity is not rigid and has exceptionsIf remaining fateful to ones commitment would result in serious harm being done to another, the requirement of doing good and avoiding harm may conflict with fidelityBeneficence would pull in the direction of breaking the promise

Explicit/ ImplicitAn implicit promise is a commitment that all parties assume to exist even if no specific act of promise occurredAn explicit promise is a commitment made to another

10. Sanctity of Human LifeThe reason for killing in the healthcare sphere are usually related to mercy Someone makes a judgement that the pt would be better off deadIf its the health professionals duty to benefit pt and protect them from harm, may they assist in putting a suffering pt out of misery???

Mercy killingThe principle of beneficence and nonmaleficence, of doing good and avoiding evil, provides ready arguments to support mercy killing as well as withhold or withdraw treatmentFor pts who are competent, autonomy provides a moral basis for approving of or tolerating treatment-refusal decision by these pt

Rules of conductSome people who believe ethics is a matter of consequences nevertheless maintain that consequences should be used to judge rules of conduct involving killingThe believe that a rule against killing even for mercy will have better consequences

WithholdDoes the avoidance of killing apply only to active killing or does it also extend to decisions to let a person die?Is there a difference between actions and omissionsIf a pt is inevitably dying , many people believe that it is morally preferable to withhold or withdraw treatment, than to intervene actively to kill a pt

Intended killingsSometimes persons are killed without the intention of doing so, as in anesthesia accidentSome theology or philosophic debates make a distinction between accidental and intended killingsThe doctrine of double effect holds that some deaths are morally permissible, if four conditions are met

Conditions are1. The action is good or indifferent in itself2. The intention of the agent is upright, the evil effect is sincerely not intended3. The evil effect is equally immediate causality with the good effect; it is not a means to good effect4. There must be a proportionally grave reason for allowing the evil to occur

EuthanasiaSome people are now advocating the legalization of assistance suicide or mercy killing, when a competent pt wants life endedIn Netherlands physicians who commit euthanasia is not prosecuted and it is now legalJack Kevorkian has done a number of assisted suicide on request of pt

ANAANA believes that the nurse should not participate in assisted suicideSuch an act is a violation of the Code for Nurses with interpretive statements and the ethical tradition of the professionNurses have no obligation to provide compassionate end-of-life care

WithholdingControversial decisions are withholding medications, CPR, medically supplied nutrition and hydration (Terri Schiavo case)

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